I. Preventive: It is indicated in following situations-
1. Migraines occur twice a month, producing disability that lasts three days or longer
2. Medication that treats symptoms or tries to stop an attack are not best for patients or are not working
3. Pattern of migraine attacks are predictable, such as menstrual migraines
Drugs commonly used are Flunarizine, Propranolol, Methysergide, Amitriptyline, Carbamazepine, Divalproex sodium etc.
Interventional Pain Management: Injections of Botulinum Toxin in the scalp prevent migraine attack for prolonged period.
II. Avoidance of triggers: Researchers have found that trigger factors often provoke migraine attacks. Studies have shown that avoiding these trigger factors could reduce the frequency of migraine attacks by half. They are as follows:
Foods Aged cheese, Alcohol, MSG, Chocolate, Caffeine, Hot dogs, Bacon, Luncheon meats, Avocado, Fermented or pickled foods, Yeast or protein extracts, Onions Nuts, Aspartame.
Medications Antibiotics, Antihypertensives, H2 blockers, Vasodilators.
Hormonal Factors Menstruation, Oral contraceptives, Hormone replacement therapy
Lifestyle Factors Delaying or skipping meals, Changes in sleep patterns, Stress
Environmental Changes Weather changes, High altitude, Time zone changes like jet lag.
III. Abortive: There are certain drugs used to abort the attacks of migraine headaches:
Cerebral vasoconstrictors: ergotamine tartrate, dihydroergotamine, sumatriptan, zolmitriptan etc.
Non-vasoconstrictors: Butorphanol and other narcotic analgesics.
Interventional Pain Management: Spheno-palatine Ganglion block abort acute attack of migraine.
IV. General pain management Simple analgesics like Paracetamol, Aspirin to other NSAIDs and opioids like codeine, tramadol etc.